Echocardiographic features of post−transcatheter aortic valve implantation thrombosis and endocarditis

Marco Spartera, Francesco Ancona, Marta Barletta, Isabella Rosa, Stefano Stella, Claudia Marini, Leonardo Italia, Matteo Montorfano, Azeem Latib, Ottavio Alfieri, Alberto Margonato, Antonio Colombo, Eustachio Agricola

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Background: Transcatheter heart valve thrombosis (THV-t) and endocarditis (THV-e) are relevant complications after transcatheter aortic valve implantation (TAVI). Transcatheter heart valve (THV) dysfunction definition is mostly based on Doppler (stenosis/regurgitation) without considering leaflets characteristics. Purpose: To evaluate the additional diagnostic value of leaflets echocardiographic features over Doppler when prosthetic valve complication is suspected. Methods: Among 621 post-TAVI patients, 128 cases with probable valve complication were identified. THV-t was finally diagnosed in 13 patients (10%) and THV-e in 8 (6%), while the remaining 107 (84%) had no definitive diagnosis of thrombosis/endocarditis (THV-no). We analyzed at 2 time points (baseline and follow-up) both traditional Doppler parameters and leaflets morpho-functional features. Results: Both Doppler and leaflets parameters showed high sensitivity (sensitivity 92%) and low specificity (ranging from specificity 32% to 74%) in detecting THV-t. Interestingly, the combination of mean aortic pressure gradient ≥20 mm Hg and leaflet thickening significantly improved the specificity of echocardiography for diagnosis of THV thrombosis (specificity 94%). On the other hand, echocardiographic diagnosis of THV endocarditis remained limited by very low sensitivity despite showing high specificity. Conclusions: The combination of Doppler and leaflets parameters can improve the echocardiographic diagnosis of THV thrombosis in post-TAVI patients with suspicious symptoms, via a significant increase in the overall test specificity. This would potentially allow more rational gatekeeping to more expensive/invasive diagnostic examinations (eg, CT scan) or therapeutic trials (eg, unnecessary anticoagulation).

Original languageEnglish (US)
Pages (from-to)337-345
Number of pages9
JournalEchocardiography
Volume35
Issue number3
DOIs
StatePublished - Mar 2018
Externally publishedYes

Keywords

  • echocardiography
  • endocarditis
  • thrombosis
  • transcatheter aortic valve implantation (TAVI)

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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